Toward Population Health Improvement
Tracey MoorheadPresident and CEOMay 21, 2008
What Did Disease Management Originally Mean?
Healthy/Low Risk At Risk High Risk ChronicDisease
Complex &Catastrophic
Chronic Condition
Management
Healthy/Low Risk At Risk High Risk ChronicDisease
Complex &Catastrophic
Chronic Condition
Management
Population Risk Segments
Industry Today
Healthy/Low Risk At Risk High Risk ChronicDisease
Complex &Catastrophic
Chronic Condition
Management
HealthCoachingWellness
Programs
Intensive Case Management
Healthy/Low Risk At Risk High Risk ChronicDisease
Complex &Catastrophic
Chronic Condition
Management
HealthCoachingWellness
Programs
Intensive Case Management
Population Risk Segments
“DM” is an Outmoded LabelPopulation Health Spectrum
Rebranding
DMAA launched rebranding initiative early 2007Objective: accurately reflect scope of membership and industry and recognize:
Limiting nature of “disease management”Expansion of services and providersEvolution of health care team concept
Refining our Vision
All stakeholders in the health care continuum are aligned toward
optimizing the health of populations.
Our GoalsPromoting population health improvement to:
Raise the quality of health careImprove health care outcomesReduce preventable health care costs
Through the Care Continuum:Health and wellness promotionDisease managementComplex care coordination
Population Health Improvement
Central care delivery and leadership role of the primary care physician.
Critical importance of patient activation, involvement and personal responsibility.
Patient focus and expanded care coordination capacity provided by wellness, disease and chronic care management programs.
Three core components:
Population Health ImprovementAims to improve population healthReduces health inequities among population groups.Recognizes influence of multiple physical, environmental, socioeconomic factors.Improves a population’s total physical, mental, social well-being by managing the individual.Gives individuals tools to make choices for better health and, in turn, reduce preventable medical expenses for population
A Changing LandscapeGrowth of prevention, wellness initiatives.Advances in program design and rise of behavioral health.Expanded role for health IT and need for interoperability.Recognition of threat posed by chronic conditions in an aging population.Shortage of health care providers: nurses, general practitioners, geriatricians.
What’s at Stake?Looming Part A Trust Fund insolvency in 2019.Health care to consume entire GDP in 75 yrs.Chronic conditions proliferating.PCP, nursing shortages regionally, and worsening.U.S. business competitiveness, wages undermined.Offshoring trend related partly to high health cost.1st American generation to have lower longevity than their parents?
ChallengesDemonstrating valueAligning incentives and reimbursementsPatient engagement and trustCoordination of all providers
Foundations of PHIPhysician EngagementPatient EngagementEvidence-based care advocacy
Strategic Approach toHealthcare
Integrating Population Health Strategies
Not competitive with or replacement for MHPopulation health strategies, technologies, expertise and systems complement physician-led care models
NCQA PPC-PCMH
Additional revenue likely required for Medical Home to work as envisioned
RUC recommendationsMedPAC
NCQA PPC-PCMH9 Elements for Recognition
Access and CommunicationPatient Tracking and RegistryCare ManagementPatient Self-Management SupportElectronic PrescribingTest TrackingReferral TrackingPerformance Reporting and ImprovementAdvanced Electronic Communications
Population Health StrategiesSupport practitioner-patient relationship.Utilize plan of care across continuum.Offer resources to fill gaps in patient health literacy, knowledge, timeliness of treatment.Assist physicians and groups with limited resources for care coordination.Support evidence-based processes.
Supportive Industry RoleAddress scalability concernsSupport healthcare providers in new rolesAssist with outcomes evaluations – clinical and financialLend experience in practice redesign efforts –culture, process, etc.
DMAA and PhysiciansPhysician Engagement Committee
Population Health Improvement Principles
PHI Strategies White Paper
Physician Satisfaction Survey
Patient-Centered Primary Care Collaborative
DemonstratingValue
DoesDisease Management
Save Money?
Typical Questions Posed
Implied question: Do programs always work for every condition in every population?“Work” means short-term savings, ROI.Assumes that DM is a monolithic intervention, similar to drug or procedure.
Better question:Do PHI ProgramsImprove Quality
and Deliver Value?
A More Useful Perspective?Does PHI ever work for any condition in any population?Which outcomes are impacted and in what sequence, over what timeframe? How are various PHI programs different?How do those differences affect results?How important is personalization of PHI?How important is collaboration with MDs?
“Squeezing the Bookends”
The DMAA Method
Single Standardized Approach for All DM Outcomes
DMAA Outcomes
Project
DMAA Outcomes
Project
Existing Spectrum of DM Outcomes Measures/Methods
More Casual More Rigorous
Narrower Spectrum of DM Outcomes Measures/Methods
More Casual More Rigorous
Achieving Optimal Balance
“Suitability” “Acceptability”
RigorPrecision
ReplicabilityEvidence-based
Bias, ConfoundersCausal Association
Experimental Design
CostTimeEase
SimplicityAccessibilityTransparencyDiverse Users
Outcomes GuidelinesVolume I, released December 2006Focused on evaluating financial outcomes.Responded to gap in consistent evaluation methods in disease management.DMAA convened numerous stakeholders in transparent, consensus-driven process
Outcomes GuidelinesVolume II, released September 2007.
DMAA collaborated throughout with leading quality, accrediting organizations—NCQA, URAC, Joint Commission.
Guidelines praised for sound methodology.
Next Steps/Current WorkVolume III- September 2008.Continue partnership with NCQA to expand, refine disease-specific clinical measures.Operational definitions, measures with URAC.Work toward standardized selection criteria.Refinement of current guidelines to compare performance across programs.Describe measures for wellness evaluation.
Medicaid InnovationsMedicaid initiatives well-developed and widespread.Increasing innovation.Numerous success stories—Florida, Wyoming and Georgia, among many others.Programs demonstrate a positive return on investment and improved care.
Medicare as LaboratorySpecial Needs PlansMedicare Health SupportMedicare Care Coordination DemonstrationCare Management for High Cost BeneficiariesSenior Risk ReductionMedical Home Demonstration
Market Continues to GrowValue proposition evidenced by dramatic industry growth in past decadeHealth Plan penetration >90%Employer and Medicaid growth >50%International adoption growing rapidly - value perception independent of nationalityEmployers overcome any doubt about short-term direct health savings with indirect health benefitsBuyers seem satisfied with value of their experiences
PHI OutlookFuture remains bright for population health.Studies continue to build clinical and financial case for PHI.Need for chronic care solutions on national stage—PFCD, IOM geriatric report, others.
Learn MoreDMAA: The Care Continuum Alliance
www.dmaa.org(202) 737-5980
Sept. 7 to 10, 2008 . Westin Diplomat Resort & Spa . Hollywood, FL